The orthopedic-oncology service - Hôpital Maisonneuve

The orthopedic-oncology service :
a multidisciplinary team
The orthopedic-oncology service at MaisonneuveRosemont Hospital provides care to patients from
the many regions of Quebec and the Maritimes. This
hospital is one of the three reference centres in Quebec,
specializing in the treatment of musculoskeletal tumours.
The orthopedic-oncology service treats approximately 400
patients each year and we also work in partnership with
the Ste-Justine Children’s Hospital.
We treat malignant tumours, otherwise known as
sarcomas, as well as other tumours which affect bone
and soft tissues.
The types of sarcomas most frequently treated are :
• Osteosarcomas ;
• Ewing’s sarcomas ;
• Chondrosarcomas ;
• Soft tissue sarcomas (liposarcomas, synovial
sarcomas), etc.
We also treat benign tumours, which represent
approximately 58% of new patients evaluated each year.
The orthopedic-oncology team works in a multidisciplinary
fashion, meaning that it functions in partnership with
other specialties in the field, such as oncologic surgery,
diagnostic radiology, pathology, radiation-oncology and
medical oncology. On the paramedical level, the team
includes specialized nursing care, physical therapy, a
social worker, a psychotherapist and a research team.
Any decision pertaining to the treatment of a patient is,
therefore, a consensus between different experts. This
pamphlet will be useful in understanding the different
stages of your diagnosis and treatment, and will also
serve as a guide to orient your questions toward the right
people.
The diagnosis of a tumour is a difficult ordeal for you and
those surrounding you. It is therefore important to be able
to understand the necessity of the different diagnostic
examinations, as well as the implications of the different
treatments on your lifestyle. Throughout your treatment,
you will be meeting different specialists of the
orthopedic-oncology department.
Diagnostic imaging
You will have to undergo different examinations in
order for your doctor to be able to formulate a precise
diagnosis. Imaging techniques used for such evaluations
may include x-rays, which evaluate the extent to which
the skeleton may have been affected by the tumour, as
well as your lungs.
The CT-scan functions like the standard x-ray. However,
the CT-scan produces images in fine layers and from
different angles, allowing for more precise and in depth
images. This examination is generally used to verify the
state of your lungs, and sometimes other regions of the
body, such as the abdomen.
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Magnetic resonance creates precise images of soft
tissues such as the muscles, tendons, liquids, nerves,
etc. without having to resort to x-rays. The apparatus
uses magnetic waves to vibrate the tissues of your
body in order to create the image. There is no radiation
associated with this examination, which is painless. The
images obtained by this procedure are essential, for they
determine which structures are invaded by the tumour
and allow the team to decide upon the best course of
treatment.
The biopsy
The goal of a biopsy is to sample the tissue of a mass
so that it may be submitted to a microscopic examination
by a qualified pathologist. There are several forms of
biopsies.
Biopsies may be carried out at the outpatient clinic using
a special needle. Local anesthesia, similar to that used
by dentists, renders the procedure nearly painless. The
procedure is comparable to a blood test. On occasion, a
CT-scan may be used to guide the needle to the desired
area. If this is the case, the biopsy will take place in the
radiology department at a later date.
In more difficult cases, it is necessary to perform an open
biopsy in the operating room. This consists of a small
operation that allows for a larger sample of the tumour.
This type of biopsy leaves a scar of variable length,
generally less than 5 cm.
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In all cases, the care of the wound will be explained to
you. Painkillers will be prescribed to you for the pain,
which may be present for 24 to 48 hours following the
biopsy.
The definitive results of your biopsy are usually available
in the seven to ten days following the procedure. A further
delay is sometimes necessary if certain special tests
have been requested. Your surgeon will communicate
the results of your biopsy to you once they are available,
whether by appointment at the clinic or by telephone.
You may discuss how you wish your orthopedist to
communicate the results of your biopsy to you.
The treatments
Following the diagnosis of your tumour, the specialist
doctor will decide upon the best form of treatment to
adopt, and whether or not radiotherapy, chemotherapy,
and/or surgery will be necessary. In certain cases, surgery
is the only appropriate form of treatment. The optimal
form of treatment is decided upon at a multidisciplinary
conference, where different experts analyse your file, the
histological results of your biopsy and your x-rays.
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Radiotherapy
Radiotherapy uses the ionizing radiation of a linear
particle accelerator to destroy cancerous cells. The
radiation destroys the DNA of the cancerous cells,
rendering them incapable of multiplication.
The healthy cells surrounding the cancerous cells are
also damaged by the radiation, but they are generally
capable of repairing themselves.
The objective of radiotherapy is to allow for a better local
control of the tumour.
Chemotherapy
Chemotherapy is used in the treatment of certain
sarcomas. It can be administered before surgery in cases
where the volume of the sarcoma must be reduced in
order to allow for a more conservative surgical procedure.
This is called neoadjuvant chemotherapy.
Chemotherapy may also be administered after surgery
so as to diminish the risk of a recurrence of the cancer.
Palliative chemotherapy may also be offered to allow for
control of the disease while maintaining an acceptable
quality of life. Unfortunately, chemotherapy is not an
effective treatment for all kinds of sarcomas, as some
tumours are more sensitive to this treatment than others.
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Surgery
In some cases, surgery is the only effective form of
treatment. The goal of an operation is to eliminate the
tumour, as well as any neighbouring structures that have
been affected. In rare cases, when too many essential
structures have been affected (including blood vessels
and nerves), an amputation may be the only solution.
Personal ressources
It is important that you be capable of understanding
your illness, as well as the treatments that you will be
receiving. Your ortho-oncological specialist will follow
you throughout your treatment and keep in contact with
the pathology, radiotherapy, chemotherapy and imaging
departments. Many of our patients being treated for
a malignant tumour consult our psychotherapist. The
nurse manager is responsible for the coordination of the
different services and remains an available ressource
after your departure from the hospital, if needed. It is
possible that the research team will propose different
studies for you to participate in.
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Do not hesitate to contact us for more
information.
Orthopedic-oncologic surgeons
Dr Marc Isler
Dr Sophie Mottard
Dr Louis-Philippe Amiot
Tel. : 514 254-6161 / Website: http://www.hmrortho.ca
Diagnostic x-ray service
Dr Marie-Josée Berthiaume
Tel. : 514 252-3400, ext. 6114
Mme Sophie Tremblay, senior assistant
Pathology service
Dr Josée Doyon
Tel. : 514 252-3498
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Radio-oncology service (Radiotherapy)
Dr Pierre Chabot
Dr Nader Khaouam
Tel. : 514 252-3400, ext. 3425
Medical oncology service (chemotherapy)
Dr Jean-Luc Dionne Dr Julie Beaudet
Tel. : 514 252-3400, ext. 3954
Nurse manager
Carole Douville
Tel. : 514 252-3400, ext. 6165
Équipe de recherche
Janie Barry
Tel. : 514 252-3400, ext. 4428 / Email: jbarry.hmr@ssss.gouv.qc.ca
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Psychotherapist
Robert Langlois
Tel. : 514 252-3400, ext.
Psychotherapist
Claudia Maltais
Stéphanie Fradette
Tel. : 514 252-3400, ext. 6561
Users’ committee
President : Louis-Gilles Faucher
Tel. : 514 252-3925
Email : cusagers.hmr@ssss.gouv.qc.ca
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Hôpital Maisonneuve-Rosemont
Adresse postale
5415, boul. de l’Assomption
Montréal (Québec) H1T 2M4
514-252-3400
Free translation of :
L’Équipe multidisciplinaire du service d’orthopédie-oncologie
Tous droits réservés
©HMR; orthopédie-oncologie, 2011
CP- CHR-098 (ANGL)